Institute of Medicine Issues Recommendations on End-of-Life Care

A committee of experts convened by the Institute of Medicine issued a series of recommendations to support a “person-centered, family-oriented approach” to end-of-life care that “honors individual preferences and promotes quality of life.” According to the report, barriers to high quality end-of-life care include fragmentation in care delivery, inadequate numbers of palliative care specialists, and perverse financial incentives that promote acute care. The committee also found that palliative care promotes a higher quality of life for people with advanced serious illness, better communication between patients and professionals, and better access to supports, but is not well understood by health care professionals or the public.

The committee’s key recommendations include:  

• Government and commercial health care payers should cover the provision of comprehensive care for individuals with advanced serious illness who are nearing the end of life.
• Skilled palliative care and, when appropriate, hospice care should be available to patients with advanced serious illness.
• Palliative care should include access to an interdisciplinary team, including board-certified hospice and palliative medicine physicians, nurses, social workers, chap­lains and other health professionals as needed (including geriatricians).
• Professional societies and other standard-setting organizations should develop standards for clinician–patient communication and advance care planning that are measurable, actionable and evidence-based. Reimbursement should be tied to adherence to those standards.
• Organizations responsible for educating clinicians or accrediting providers should establish the necessary training requirements to strengthen the palliative care knowledge of all clinicians who care for indi­viduals with advanced serious illness.
• Government and commercial health care payers should integrate the financing of medical and social services to support high quality, end-of-life care consistent with the values, goals and preferences of people with advanced serious illness. Financial incentives should promote improved shared decision making and advance care planning; require the use of interoperable EHRs that incorporate advance care plan­ning (including applications like eMOLST); and encourage states to develop and implement a Physician Orders for Life-Sustaining Treatment (MOLST in New York State) program.
• Government and community-based organizations should provide factual information about care options for people with advanced serious illness to encourage advance care planning and informed decisions based on individuals’ needs and values.
• Health care providers should offer information about end-of-life care to support clinicians’ ongoing dialogue with patients, families and caregivers.

The Institute of Medicine is the health arm of the National Academy of Sciences.

Contact:  Karen Lipson, klipson@leadingageny.org, 518-867-8383, ext. 124